The Incidence and Risk Factors for Dental Injury in Patients Undergoing General Anesthesia: A Case-Control Study

Sarinya Chanthawong,1 Saranyoo Nonphiaraj,1 Lady Vongtongchith,2 Nutrada Tisangka,3 Junjira Kaewaun,3 Peerapong Sangsungnern,1 Thitinuch Ruenhunsa,1 Laksanawadee Chairatana3 1Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Faculty of Medicine, University of Health Sciences, Vientiane Capital, Laos; 3Division of Nursing, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Saranyoo Nonphiaraj, Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand, Tel +66-43-363060, Email [email protected]: Dental injury is a known complication of endotracheal intubation during general anesthesia (GA), yet data on its incidence and associated risk factors remain limited. This study aimed to evaluate the incidence, risk factors, and outcomes of dental injury in patients undergoing GA.Patients and Methods: This retrospective case-control study was conducted between January 2021 and June 2024. A total of 42,826 patients underwent GA during the study period; 72 cases of dental injury were identified from the departmental database. Controls were time-matched patients who underwent surgery in the same anatomical region, using a case-to-control ratio of 1:4. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors for dental injury.Results: The incidence of dental injury was 0.17%. Univariate analysis identified the following factors as associated with dental injury: age ≥ 60 years, pre-existing dental pathology, Mallampati classification ≥ 3, anticipated difficult intubation, and difficult airway. In the multivariable logistic regression analysis, pre-existing dental pathology (adjusted OR 3.87, 95% CI: 1.92– 7.81, p < 0.001), anticipated difficult intubation (adjusted OR 4.99, 95% CI: 1.84– 13.50, p = 0.002), and difficult intubation (laryngoscopic view grade ≥ 3) (adjusted OR 10.56, 95% CI: 4.24– 26.29, p < 0.001) remained significant independent predictors of dental injury during GA. The most common complication was bleeding.Conclusion: Dental injury during GA is uncommon, with an incidence of 0.17%. Pre-existing dental pathology, anticipated difficult intubation, and poor laryngoscopic view (grade ≥ 3) were identified as independent risk factors. Awareness and thorough preoperative assessment of these factors may help reduce the risk of dental injury and related complications.Keywords: incidence, risk factor, dental injury, dental trauma, general anesthesia, complication